Gastric and enteral tube feeding is commonplace in our healthcare system and plays an important role in supporting nutritional needs for patients unable to ingest food, such as patients suffering from coma, stroke, cancer, and gastro-intestinal disorders. Maintenance and care of an enteral feeding tube, particularly a gastrostomy or jejunostomy feeding tube, and the associated stoma site is labor intensive and generates significant healthcare expenditures. Improper feeding tube and stoma care can result in costly emergency department visits, hospital admissions, or even morbidity.
Different methods exist for placing enteral feeding tubes, including surgical, endoscopic, and radiological methods. If placed into the stomach, all three methods result in the gastric wall being juxtaposed to the abdominal wall through a tunneled tract (also referred to as a “fistula”). As an alternative to open surgery, a common method for insertion of a gastrostomy tube is the percutaneous endoscopic gastrostomy (PEG) placement, which is described in detail in U.S. Patent Publication No. 2009/0216186 A1 and U.S. Pat. No. 5,073,166.
Despite the indication, the size required, or the vendor, gastrostomy feeding tubes are manufactured commonly from biocompatible polymers and have an internal retention member (such as, for example, a gastric balloon or bumper) and an external retaining member. In order to prevent leakage of gastric contents from the gastric lumen through the fistula and onto the skin, the internal retention member must be firmly compressed to the gastric opening of the fistula. In the immediate post-placement period, gastric leakage is uncommon for two reasons. The edema or swelling from tissue injury at the placement site causes an initially snug fit between the internal retention member and external retaining member. Secondly, the static coefficient of friction generated by the inner smooth surface of the external retaining member and external smooth polymer surface of the gastrostomy tube is optimized when initially placed because the materials are new. Thus, the combination of post-operative swelling and the optimal frictional force between the device components typically prevents immediate post-operative leakage. It is also common practice during the gastrostomy tube procedure to place a silk suture tightly around the neck portion of an external retaining member to increase the frictional force against the gastric tube, because it is widely recognized that, with time, the static friction between the tube shaft and external retaining member will inevitably be overcome by dynamic friction. The external retaining member can initially be secured to the skin surface with sutures. As swelling reduces and the tube materials wear, the gastrostomy balloon is able to move away from the gastric wall allowing gastric contents to leak out around the gastrostomy tube and onto the skin. Emergency department visits for immediate treatment are prompted when this occurs.
In view of the current problems, there is a need for a gastric feeding tube device that can be easily adjusted to accommodate for changes in the tissues around a fistula and stoma. An exemplary device would have an ergonomic design that is comfortable to wear and easy to place, and that can be utilized no differently than conventional devices. Ideally, such a gastrostomy feeding tube will be adjustable by a healthcare provider or patient without surgical intervention.